使用双β-内酰胺类药物的氨基糖苷类药物稀释疗法成功治疗阿迪阿克氏肉芽肿菌人工主动脉瓣心内膜炎--改变模式的时机到了吗?

IF 3.4 Q2 INFECTIOUS DISEASES
Alberto Pagotto, Floriana Campanile, Paola Conti, Francesca Prataviera, Paola Della Siega, Sarah Flammini, Simone Giuliano, Luca Martini, Davide Pecori, Assunta Sartor, Maria Screm, Tosca Semenzin, Carlo Tascini
{"title":"使用双β-内酰胺类药物的氨基糖苷类药物稀释疗法成功治疗阿迪阿克氏肉芽肿菌人工主动脉瓣心内膜炎--改变模式的时机到了吗?","authors":"Alberto Pagotto, Floriana Campanile, Paola Conti, Francesca Prataviera, Paola Della Siega, Sarah Flammini, Simone Giuliano, Luca Martini, Davide Pecori, Assunta Sartor, Maria Screm, Tosca Semenzin, Carlo Tascini","doi":"10.3390/idr16020020","DOIUrl":null,"url":null,"abstract":"<p><p>(1) Background: <i>Granulicatella adiacens</i> is a former nutritionally variant streptococci (NVS). NVS infective endocarditis (IE) is generally characterized by a higher rate of morbidity and mortality, partially due to difficulties in choosing the most adequate microbiological culture method and the most effective treatment strategy, and partially due to higher rates of complications, such as heart failure, peripheral septic embolism, and peri-valvular abscess, as well as a higher rate of valve replacement. Depending on the affected valve (native valve endocarditisNVE, or prosthetic valve endocarditisPVE), the American Heart Association (AHA) 2015 treatment guidelines (GLs) suggest penicillin G, ampicillin, or ceftriaxone <i>plus</i> gentamicin (2 weeks for NVE and up to 6 weeks for PVE), while vancomycin alone may be a reasonable alternative in patients who are intolerant of β-lactam therapy. The European Society of Cardiology (ESC) 2023 GLs recommend treating NVE with penicillin G, ceftriaxone, or vancomycin for 6 weeks, suggesting combined with an aminoglycoside (AG) for at least the first 2 weeks only for PVE; likewise, the same recommendations for IE due to Enterococcus faecalis. (2) Methods: Starting from the case of a 51-year-old man with <i>G. adiacens</i> aortic bio-prosthesis IE who was successfully treated with aortic valve replacement combined with double beta-lactams, an AG-sparing regimen, we performed microbiology tests in order to validate this potential treatment change. (3) Results: As for <i>E. faecalis</i> IE, we found that the combination of ampicillin <i>plus</i> cephalosporines (like ceftriaxone or ceftobiprole) showed a synergistic effect in vitro, probably due to wider binding to penicillin-binding proteins (PBPs), thus contributing to enhanced bacterial killing and good clinical outcome, as well as avoiding the risk of nephrotoxicity due to AG association therapy. (4) Conclusions: Further studies are required to confirm this hypothesis, but double beta-lactams and an adequate sourcecontrol could be a choice in treating <i>G. adiacens</i> IE.</p>","PeriodicalId":13579,"journal":{"name":"Infectious Disease Reports","volume":"16 2","pages":"249-259"},"PeriodicalIF":3.4000,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961776/pdf/","citationCount":"0","resultStr":"{\"title\":\"An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat <i>Granulicatella adiacens</i> Prosthetic Aortic Valve Endocarditis-Time to Change Paradigm?\",\"authors\":\"Alberto Pagotto, Floriana Campanile, Paola Conti, Francesca Prataviera, Paola Della Siega, Sarah Flammini, Simone Giuliano, Luca Martini, Davide Pecori, Assunta Sartor, Maria Screm, Tosca Semenzin, Carlo Tascini\",\"doi\":\"10.3390/idr16020020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>(1) Background: <i>Granulicatella adiacens</i> is a former nutritionally variant streptococci (NVS). NVS infective endocarditis (IE) is generally characterized by a higher rate of morbidity and mortality, partially due to difficulties in choosing the most adequate microbiological culture method and the most effective treatment strategy, and partially due to higher rates of complications, such as heart failure, peripheral septic embolism, and peri-valvular abscess, as well as a higher rate of valve replacement. Depending on the affected valve (native valve endocarditisNVE, or prosthetic valve endocarditisPVE), the American Heart Association (AHA) 2015 treatment guidelines (GLs) suggest penicillin G, ampicillin, or ceftriaxone <i>plus</i> gentamicin (2 weeks for NVE and up to 6 weeks for PVE), while vancomycin alone may be a reasonable alternative in patients who are intolerant of β-lactam therapy. The European Society of Cardiology (ESC) 2023 GLs recommend treating NVE with penicillin G, ceftriaxone, or vancomycin for 6 weeks, suggesting combined with an aminoglycoside (AG) for at least the first 2 weeks only for PVE; likewise, the same recommendations for IE due to Enterococcus faecalis. (2) Methods: Starting from the case of a 51-year-old man with <i>G. adiacens</i> aortic bio-prosthesis IE who was successfully treated with aortic valve replacement combined with double beta-lactams, an AG-sparing regimen, we performed microbiology tests in order to validate this potential treatment change. (3) Results: As for <i>E. faecalis</i> IE, we found that the combination of ampicillin <i>plus</i> cephalosporines (like ceftriaxone or ceftobiprole) showed a synergistic effect in vitro, probably due to wider binding to penicillin-binding proteins (PBPs), thus contributing to enhanced bacterial killing and good clinical outcome, as well as avoiding the risk of nephrotoxicity due to AG association therapy. (4) Conclusions: Further studies are required to confirm this hypothesis, but double beta-lactams and an adequate sourcecontrol could be a choice in treating <i>G. adiacens</i> IE.</p>\",\"PeriodicalId\":13579,\"journal\":{\"name\":\"Infectious Disease Reports\",\"volume\":\"16 2\",\"pages\":\"249-259\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-03-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961776/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infectious Disease Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3390/idr16020020\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infectious Disease Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/idr16020020","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

摘要

(1) 背景:Granulicatella adiacens 是一种前营养变异链球菌(NVS)。NVS感染性心内膜炎(IE)的发病率和死亡率通常较高,部分原因是难以选择最适当的微生物培养方法和最有效的治疗策略,部分原因是并发症发生率较高,如心力衰竭、外周化脓性栓塞和瓣周脓肿,以及瓣膜置换率较高。根据受影响瓣膜的不同(原发瓣膜心内膜炎NVE或人工瓣膜心内膜炎PVE),美国心脏协会(AHA)2015年治疗指南(GLs)建议使用青霉素G、氨苄西林或头孢曲松加庆大霉素(NVE用药2周,PVE用药最多6周),而对于不能耐受β-内酰胺类药物治疗的患者,单用万古霉素可能是一个合理的替代方案。欧洲心脏病学会(ESC)2023 GLs 建议使用青霉素 G、头孢曲松或万古霉素治疗 NVE,疗程为 6 周,建议与氨基糖苷类药物(AG)联合治疗至少头 2 周,仅用于 PVE;同样,对于由粪肠球菌引起的 IE,也有相同的建议。(2)方法:一名 51 岁的男性主动脉生物假体感染 G. adiacens IE 患者成功接受了主动脉瓣置换术联合双β-内酰胺类药物治疗,这是一种节省 AG 的治疗方案,我们从该患者的病例出发,对其进行了微生物学检测,以验证这一潜在的治疗变化。(3)结果:对于粪肠球菌 IE,我们发现氨苄西林联合头孢菌素(如头孢曲松或头孢比洛)在体外显示出协同作用,这可能是由于与青霉素结合蛋白(PBPs)的结合范围更广,从而有助于增强杀灭细菌的能力,取得良好的临床疗效,并避免了 AG 联合疗法导致的肾毒性风险。(4)结论:这一假设还需要进一步的研究来证实,但双重β-内酰胺类药物和充分的源头控制可能是治疗 G. adiacens IE 的一种选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An Aminoglycoside-Sparing Regimen with Double Beta-Lactam to Successfully Treat Granulicatella adiacens Prosthetic Aortic Valve Endocarditis-Time to Change Paradigm?

(1) Background: Granulicatella adiacens is a former nutritionally variant streptococci (NVS). NVS infective endocarditis (IE) is generally characterized by a higher rate of morbidity and mortality, partially due to difficulties in choosing the most adequate microbiological culture method and the most effective treatment strategy, and partially due to higher rates of complications, such as heart failure, peripheral septic embolism, and peri-valvular abscess, as well as a higher rate of valve replacement. Depending on the affected valve (native valve endocarditisNVE, or prosthetic valve endocarditisPVE), the American Heart Association (AHA) 2015 treatment guidelines (GLs) suggest penicillin G, ampicillin, or ceftriaxone plus gentamicin (2 weeks for NVE and up to 6 weeks for PVE), while vancomycin alone may be a reasonable alternative in patients who are intolerant of β-lactam therapy. The European Society of Cardiology (ESC) 2023 GLs recommend treating NVE with penicillin G, ceftriaxone, or vancomycin for 6 weeks, suggesting combined with an aminoglycoside (AG) for at least the first 2 weeks only for PVE; likewise, the same recommendations for IE due to Enterococcus faecalis. (2) Methods: Starting from the case of a 51-year-old man with G. adiacens aortic bio-prosthesis IE who was successfully treated with aortic valve replacement combined with double beta-lactams, an AG-sparing regimen, we performed microbiology tests in order to validate this potential treatment change. (3) Results: As for E. faecalis IE, we found that the combination of ampicillin plus cephalosporines (like ceftriaxone or ceftobiprole) showed a synergistic effect in vitro, probably due to wider binding to penicillin-binding proteins (PBPs), thus contributing to enhanced bacterial killing and good clinical outcome, as well as avoiding the risk of nephrotoxicity due to AG association therapy. (4) Conclusions: Further studies are required to confirm this hypothesis, but double beta-lactams and an adequate sourcecontrol could be a choice in treating G. adiacens IE.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Infectious Disease Reports
Infectious Disease Reports INFECTIOUS DISEASES-
CiteScore
5.10
自引率
0.00%
发文量
82
审稿时长
11 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信